Content warning: This post is about my weight-loss journey, and I know body shaming is insidious and one of those buttons anyone can push. I know everyone has a complex relationship with how they see themselves. "Thinness" isn't my goal. I entered this process to increase my energy and lower my long-term risk for health complications.

If we define body image by what we see when we look in the mirror, then I see my 18-year-old self right around 200 pounds every day when I look in the mirror.

Over the years, I'd shave and see my self-image and then take a picture and be shocked by the difference between what I see in the picture and what I see in the mirror. I didn't go from 165 pounds in high school to 350 at 41 years old overnight.

It was a journey of fits and starts.

The foundation for this transformation is rooted in my relationship with food, which I learned to use as a form of emotional control. I grew up in a religious tradition where drugs and alcohol were not socially acceptable ways to let off steam or stress. But I could demolish a bag of chips in one sitting, and no one would say anything.

Bored? Let's eat. Stressed? Where's the sugar!?!

Now that I've shared a bit of context about my relationship with food and body image, let's talk about what I've learned about myself over the last couple of years.

👇🏻 That's me in April 2021 side by side from May 2023👇🏻

How I got to 2021

I quit playing baseball during my junior year of high school, for my friends who grew up outside the US I was 17 at this point.

Between the time I stopped playing baseball and my graduation, I went from 165 to 200 pounds. Then another 40 pounds during the first few years of college, and during my last semester I gained another 25 pounds as I worked 40 hours a week and took 19 hours of classes to graduate in December 2004.

When Jen and I got married, I weighed 265 pounds, and from there, I gained weight in 10-pound chunks until I hovered in the 310-320 pound range. Then COVID changed the world overnight, and during the first year of self-isolation, I gained 30 more pounds to reach my heaviest point at 350 pounds.

Looking back at all those times when I gained weight? Those are the most stressful periods of my life.

Why do I gain weight when I'm stressed?

Let's unpack what I learned about my brain that helped change this pattern in three different phases.

Phase 1: ADHD diagnosis and treatment

We were a year into COVID, and I was struggling. We were still waiting for the vaccines, and every new variant got the "Is it more deadly than the original? We don't know...but it could be. Here's why you should worry." treatment.

I spent days spiraling. Doomscrolling. Planning elaborate "escape to the mountains" survival scenarios. My work wasn't slipping, but I was treading water and not hitting all of my personal goals.

At this point, I finally gave in to Jen's advice to talk to my doctor about ADHD.

We spent a few years working to help one of our kids understand how their brain works, and I assembled this list of ADHD markers to make sure I didn't forget anything while talking to the doctor. I read him this list...

• fidgeting
• all-or-nothing mentality
• hyper fixation
• inconsistent sense of time (see hyper fixation)
• inability to focus, even when there are no distractions
• difficulty switching tasks
• forgetting thoughts immediately after having them
• rejection sensitivity, not starting projects I'm afraid won't be a success
• react, then think

...and the doctor said, "Yup, sounds like you have ADHD too!" From there, we talked about the next steps, and he shared that even though he was sure I had ADHD, he couldn't prescribe ADHD stimulant meds. I needed to find a psychiatric provider who could confirm my diagnosis and start to look for the right ADHD med for my brain.

It took me a couple of months to get in to see an APRN, but at this point, I saw the path forward and pursued it.

Phase 1: ADHD diagnosis and treatment ✅

Phase 2: Medical weight-loss

Right before I started my ADHD journey, I noticed a few of my friends had lost a bunch of weight. When I asked them about it, they shared they were seeing a medical weight-loss coach.

After my ADHD diagnosis, it felt like it was time to check out this coach and see if it could help me get a handle on my weight.

Remember how the stress of life during COVID led me to gain 30 pounds? I knew I needed help, and with my ADHD meds, I felt I had the extra space to make another significant change.

On my first visit, Kaitlin took a survey. She asked me about how I ate. How often, what kind of food, snacks...the whole list. As we wrapped up, she looked at me and said, "It sounds like you eat more when you're stressed."

The clouds moved out of the way, the sun came out, and birds started singing.

"Yes. I see that pattern too now," and away we went. She prescribed Wellbutrin and Naltrexone; there's a brand name for those components called Contrave. You might recognize Wellbutrin, an anti-depressant/mood-enhancer, and Naltrexone is used to help treat alcohol and opioid abuse. It also changes how brains process the reward mechanism they get from sugar and reduces sugar cravings.

There were other tools she could use, but we started by addressing my stress eating to see how far it could take us.

Over the next three months, I dropped below 300 lbs for the first time since 2016.

How would this be different from Nutrisystem, keto, and every other diet I tried? Ok, I'm getting ahead of myself here... let's check this one off.

Phase 2: Medical weight-loss ✅

Phase 3: Therapy (or It all comes together)

What happens when you remove one form of stress relief without replacing it with another? All that pressure has to go somewhere, and I white-knuckled my anger response. My ADHD medicine gave my brain space to think before I reacted, and that helped me avoid taking my stress out on my family. But no matter how hard I tried, I knew stress would leak out and impact the people I love the most.

After years of considering therapy but never pursuing it, I asked some friends for advice on finding a therapist I could trust. Their suggestion was to look for therapists in my area on Psychology Today, learn more about the type of therapy they offer, and remember you can change therapists, or stop treatment altogether, whenever you need.

I took this advice, found a therapist to try, and set up an initial appointment for early 2022. For this post, let's call my therapist, "Leia." That's not her name, but "my therapist" got repetitive, so I needed to pick one for her.

During that first visit, I shared why I was trying therapy for the first time and unpacked the changes in my life during the pandemic. All the things I learned from my ADHD diagnosis, my medical weight-loss journey, and the realization I needed to do more work to be the kind of partner, dad, friend, and colleague I want to be.

Our early focus was presence, and Leia shared some practical tactics and techniques to help me be in the moment. My ADHD brain compresses A to Z when I process information, and one of the weird things it does to me as a parent is I can take little things today and extrapolate them out to why our kids were going to fail to thrive as adults.

Those extrapolations, rooted in fear, pushed me to react to that imaginary worry. The moments I regret most as a parent are when I reacted to that imaginary future.

Leia (my therapist) gave me homework and asked me to practice breathing mediations three times a day for two weeks before our next appointment and to keep a journal.

The night before my follow-up appointment, I told Jen I had therapy to coordinate between our jobs and anything the kids needed. As we talked, she shared how happy she was that I was in therapy because she saw the difference my homework was making.

It wasn't a dramatic shift. What I saw was how working on being in the moment along with my ADHD medicine gave my brain space to contextualize those "what if" thoughts. Being present helped me practice better listening and stay focused on the moment and not react to a future that 99.9999% won't happen.

As Leia and I continued our work, one moment stands out when I think about my relationship to food.

During one session, we talked about stress eating. Leia ripped a clean sheet of paper off her notepad and handed it to me as we talked. Our conversation paused, and she asked me to fold the paper in half as often as I could.

Thirty seconds later, I showed her a tiny wad of paper.

Leia: "Great, now unfold and fold it the same way again."

Me: "...Ok, I'm done. Now what?"

L: "Now, instead of folding it in half, I want you to fold it in triangles."

M: "Like a paper football?"

She nodded, and I started folding. As I did, she asked me if I noticed any differences.

M: "Yeah, I can fold it into a football, but all the other creases make the paper want to fold in half."

L: "That's how your brain works. You create neural pathways, and the more you use them over time, they create habits. For your entire life, your brain treats food as stimulation. ADHD brains produce less dopamine, and that food response uses sugar and carbs to create the dopamine your brain needs in those moments."

There's way more to what I've learned in therapy, but that encapsulates the moment I understood how my ADHD and food habits weren't a moral failing or character flaw.

My brain was coping the best way it could with the tools I had at the time.

Phase 3: Therapy ✅

What's next?

My next big goal is to hit my target weight. 200 pounds is a healthy target for someone my height and build. I think I can reach that goal before the end of 2023.

Where do I go from there? I don't know. The last three years have felt like a big lifestyle shift, the kind doctors talk about leading to lasting changes in weight. But I know my relationship with food will always be a little fraught. I can't live without it, but I can't treat it as a stress reliever anymore.

How I responded to the end of 2022 could indicate how this might play out. I lost my job in a layoff in early December 2022, the absolute worst time to be looking for a marketing job in tech since at least 2008.

From December until February, I went from 250 pounds back up to 280. I knew I was eating my feelings, responding to stress by enjoying a pint of Ben & Jerry's. It took me some time to see the pattern, but when I saw it, I knew where to go for the support I needed to get back on track.

All those things I learned about my experience? They worked to help me get back on track. I talked to my weight-loss coach about my weight gain without shame or self-hatred, acknowledged my stress, and worked to get back on track.

I couldn't do this without my team: my medical professionals and, most of all, Jen. She is my constant, a source of encouragement and unconditional love that makes my life better in every way I can list.

Notes

I want to share a bit more detail outside of my narrative about my weight-loss medicine.

For the last six months, I've seen different news sources talk about "Ozempic face," and it pisses me off every time I see it. Ozempic face isn't a side effect of taking Ozempic; it's how your body looks as you lose weight.

Pathologizing the effects of weight loss like this reinforces the feelings many overweight people experience from society at large, a "damned if you do, damned if you don't" mindset about our bodies.

If you're overweight, it's because you lack self-control.

But if you lose the weight, oh my god, what's wrong with your face?!?

That's part of the reason I wanted to share all of this because I'm so tired of reading stories that don't reflect my experience. Experts quoted in these stories say that medical weight-loss interventions aren't as reliable as lifestyle changes for long-lasting changes in weight.

Well, you know what? Lifestyle changes did jackshit for me...because my negative eating habits were driven by my brain, not my body's need for fuel.

We need to work to destigmatize weight-loss medicine the same way we've destigmatized medicine that helps people's mental health.

Here's the mix of meds I've used during my journey, with links to more information about each drug.

Contrave

I mentioned this briefly earlier; this is a combo of Wellbutrin and Naltrexone that helps stop stress eating. This was the first weight-loss drug I used, and I lost almost 50 pounds before adding other medicine to my mix.

Metformin

This is a diabetes medicine designed to help lower people's blood sugar. It also suppresses appetite. I only took this for a short period of time because it made me extremely nauseous the entire time I took it. My medical provider coached me through this and shared that most people initially experience nausea, but it subsides after the first couple weeks.

I was miserable on Metformin, and we had other tools in the toolbox, so we moved on to the next medicine.

Ozempic

Yes, I took Ozempic for a few months. This was the first injectable medicine I used. It uses interchangeable needles with one syringe with your monthly prescription.

It was better than Metformin, but I still experienced intense nausea the entire time I used this medicine. After a few months, my provider asked if I wanted to try something a little different with lower reported instances of nausea as a side effect.

Mounjaro

I've been on Contrave for a couple of years, and Mounjaro is the only other medicine I've taken for over a few months. This is what helped me go from 280 to 230. It's an injectable that comes in a box of four weekly injections.

The side effects of Mounjaro have been really mild for me; the only consistent issue I've had is sulfur burps. They're gross, but when I have them, they go away a couple of days after my injection.

Wondering how this medicine works? Mounjaro is a GIP analogue that activates both the GLP-1 and GIP receptors, and these receptors send signals to your brain to tell you that you're full and don't need more food.

Eli Lily is working through the process of getting Mounjaro FDA approval as a weight-loss drug and its type-2 diabetes use case.

Paying for weight-loss healthcare

One of the big problems you'll hit with weight-loss medicine is that most insurance plans in the US don't cover the newer ones. I've never been covered for Ozempic or Mounjaro, and they are expensive y'all!

Thankfully, I've never had to pay the full out-of-pocket price for either of them. My provider keeps track of all the latest news and offers, and she got me a Mounjaro coupon last year before they made some changes that require any new coupons required a type II diabetes diagnosis.

At a recent follow up visit we talked about our plan after my Mounjaro coupon expires. She shared a list of companies that offer insurance that covers weight-loss treatment along with different options for similar medicines we can pay for out of pocket. It's a journey, so we'll see how things go from here 😊